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S. Shimmura, S. Hato, Y. Matsumoto, T. Kawakita, K. Tsubota; Simultaneous Deep Anterior Lamellar Keratoplasty (DALK) and Limbal Transplantation Using an Artificial Anterior Chamber Device. Invest. Ophthalmol. Vis. Sci. 2009;50(13):622.
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© ARVO (1962-2015); The Authors (2016-present)
Ocular surface disease with stromal involvement requires both an optical keratoplasty and stem cell transplantation. Penetrating keratoplasty (PKP) is a poor indication due to the high risk of graft rejection, while deep anterior lamellar keratoplasty (DALK) offers full stromal transplantation without the risk of rejection. We report a novel technique using an artificial anterior chamber to design custom-thickness donor buttons and thin limbal rings.
Four eyes of 3 patients with gelatinous drop-like dystrophy (GDLD: 2 eyes), ocular cicatricial pemphigoid (OCP) and Stevens Johnson syndrome (SJS) underwent simultaneous DALK and kerato-limbal allograft (KLAL). All patients had a Schirmer test value of at least 3 mm, and normal lid anatomy. DALK was performed by the viscodissection technique, followed by 360-degree KLAL. Donor corneas were fixed to an artificial chamber to produce thin-section (100 µm) donor limbal tissue. KLAL donors were fixed at the outer rim using 10-0 nylon, which were removed after 2 to 4 weeks to produce a seamless ocular surface.
All patients were followed for at least 6 months (average 13 months). A corneal epithelial phenotype was obtained in all eyes, with occasional epithelial defects observed in the SJS patient. KLAL donor tissue adapted to the recipient limbal tissue to recreate a smooth ocular surface, with normal tear meniscus observed in all patients. Visual acuity improved by more than 2 lines of vision in all eyes. No incidence of graft rejection or secondary glaucoma was observed.
Artificial anterior chambers are useful in designing donor grafts for ocular surface reconstruction by simultaneous DALK and KLAL.
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